Optic nerve head drusen (ONHD) or optic disc drusen (ODD) occurs rarely in the population, about 1% of the population, though there seems to be a genetic association as in families with a history of ONHD, it increases to almost 3.5% of those families.

In todays Grand Rounds on Webvision, we have a classic case of ONHD with typical fundus photographs, but also red-free, autofluorescence, IR and OCT captured by James Gilman of the Moran Eye Center.

A color fundus photograph (CF) shows discreet multiple yellowish calcium deposits in the optic nerve head. The Red-Free photograph (RF) reveals clearer outlines of the drusen. The Fundus AutoFluorescence photograph (FAF) shows the highly fluorescent drusen in this patient’s optic nerve. The infrared image (IR) shows small discreet reflective bodies in the optic nerve. The OCT image (OCT) shows very dense round inclusions in the optic nerve that shadow the OCT signal and indicate the shallow depth and geographic cluster of the drusen.

This imagery is from a patient with Vogt Koyanagi Harada Syndrome (VKH). VKH is a presumed autoimmune disease that presents with waxing and waning subretinal fluid. There is chromic uveitis with other neurological and dermatological symptoms. The precise mechanism of the disease is unknown, though it is thought that the autoimmune involvement of melanocytes in the uvea, skin, inner ear and CNS is mediated by T helper cells. The fundus photos above show the discoloration of the retina from fluid and the corresponding OCT below, shows the dark areas of fluid infiltration. Fundus photos were made by James Gilman of the Moran Eye Center and taken with a Zeiss FF-450+ and the OCT with with a Zeiss Stratus.